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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2023; 42(03): e220-e225
DOI: 10.1055/s-0043-1774785
Original Article

Surgical Outcome of Microvascular Decompression for Hemifacial Spasm: Symptom Control and Quality of Life

Resultado Cirúrgico da Descompressão Microvascular no Espasmo Hemifacial: Controle de Sintomas e Qualidade de Vida
Thayanna Bentes Lemanski Lopes Rodrigues 
1   Department of Neurological Sciences, Faculdade de Medicina de São José do Rio Preto (FAMERP), Hospital de Base, São José do Rio Preto, São Paulo, SP, Brazil
,
Lucas Crociati Meguins
1   Department of Neurological Sciences, Faculdade de Medicina de São José do Rio Preto (FAMERP), Hospital de Base, São José do Rio Preto, São Paulo, SP, Brazil
,
Antonio Ronaldo Spotti
1   Department of Neurological Sciences, Faculdade de Medicina de São José do Rio Preto (FAMERP), Hospital de Base, São José do Rio Preto, São Paulo, SP, Brazil
,
Carlos Eduardo Dall Aglio Rocha
1   Department of Neurological Sciences, Faculdade de Medicina de São José do Rio Preto (FAMERP), Hospital de Base, São José do Rio Preto, São Paulo, SP, Brazil
,
Waldir Antônio Tognola
1   Department of Neurological Sciences, Faculdade de Medicina de São José do Rio Preto (FAMERP), Hospital de Base, São José do Rio Preto, São Paulo, SP, Brazil
,
Dionei Freitas de Morais
1   Department of Neurological Sciences, Faculdade de Medicina de São José do Rio Preto (FAMERP), Hospital de Base, São José do Rio Preto, São Paulo, SP, Brazil
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Abstract

Introduction Hemifacial spasm (HFS) is characterized by a segmental myoclonus of the face muscles innervated by the ipsilateral facial nerve. The accepted pathophysiology of HFS suggests that it is a disease process of the nerve root entry zone associated with any neuro-vascular conflict.

Aim Review the surgical results and outcome regarding spasm control, post-operative quality of life and morbidity of microvascular decompression (MVD) for HFS from a Brazilian neurosurgical team.

Method An observational investigation was conducted with data collection from patients with hemifacial spasm treated with MVD from January 2000 to December 2015 in two different centers in the West of São Paulo State, Brazil.

Results A total of 152 patients underwent MVD for the treatment of HFS, ninety-eight (64.5%) female. Eighty-seven (57.2%) patients presented right-side spasms. The most common offending vessel was the posterior inferior cerebellar artery (PICA) with 78 (51.3%) patients. According to clinical presentation, an amount of 144 (94.7%) patients presented total control of symptoms after 36 months of follow-up. Regarding quality of life, a total of 125 (82.2%) patients referred normal quality of life after MVD for HFS and 121 (96.8%) from then were able to return to work or previous occupation. Permanent facial paresis / palsy was observed in 6 (3.6%) patients. There was no surgical mortality.

Conclusion MVD for the treatment of HFS is a safe and efficacious surgical procedure to control spasm. Neurosurgeons experience, adequate patient selection and good anatomical knowledge are fundamental to success of the treatment.

Resumo

Introdução O espasmo hemifacial (EHF) é caracterizado por mioclonia segmentar dos músculos da face inervados pelo nervo facial ipsilateral. A fisiopatologia aceita da EHF sugere que é um processo da doença da zona de entrada da raiz nervosa associada a conflito neuro-vascular.

Objetivo Revisar os resultados e desfechos cirúrgicos em relação ao controle de espasmo, a qualidade de vida pós-operatória e a morbidade da descompressão microvascular (DMV) para EHF de uma equipe de neurocirurgia brasileira.

Método Realizada investigação observacional com coleta de dados de pacientes com espasmo hemifacial tratados com DMV entre janeiro de 2000 a dezembro de 2015, em dois diferentes centros do Oeste do Estado de São Paulo, Brasil.

Resultados Um total de 152 pacientes foram submetidos a DMV, noventa e oito (64,5%) do sexo feminino. Oitenta e sete (57,2%) pacientes apresentavam espasmos no lado direito. O conflito mais comum foi com a artéria cerebelar inferior posterior (PICA) em 78 (51,3%) pacientes. Um total de 144 (94,7%) pacientes apresentou controle total dos sintomas após 36 meses de acompanhamento. Em relação à qualidade de vida, 125 (82,2%) pacientes referiram qualidade de vida normal após a MVD para HFS e 121 (96,8%) puderam retornar ao trabalho/ocupação anterior. Paresia/paralisia facial permanentes foram observadas em 6 (3,6%) pacientes. Não houve mortalidade cirúrgica.

Conclusão DMV para o tratamento da EHF é um procedimento cirúrgico seguro e eficaz para o controle do espasmo. A experiência dos neurocirurgiões, a seleção adequada dos pacientes e o bom conhecimento anatômico são fundamentais para o sucesso do tratamento.

Keywords

hemifacial spasm - microvascular decompression

Palavras-chave

espasmo hemifacial - descompressão microvascular


Publication History

Received: 28 September 2020

Accepted: 06 April 2022

Article published online:
29 September 2023

© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Chaudhry N, Srivastava A, Joshi L. Hemifacial spasm: The past, present and future. J Neurol Sci 2015; 356 (1–2): 27-31
    CrossrefPubMedGoogle Scholar
  • 2 Lu AY, Yeung JT, Gerrard JL, Michaelides EM, Sekula Jr RF, Bulsara KR. Hemifacial spasm and neurovascular compression. ScientificWorldJournal 2014; 2014: 349319
    PubMedGoogle Scholar
  • 3 Valls-Solé J. Facial nerve palsy and hemifacial spasm. Handb Clin Neurol 2013; 115: 367-380
    CrossrefPubMedGoogle Scholar
  • 4 Wang A, Jankovic J. Hemifacial spasm: clinical findings and treatment. Muscle Nerve 1998; 21 (12) 1740-1747
    CrossrefPubMedGoogle Scholar
  • 5 Wang L, Hu X, Dong H. et al. Clinical features and treatment status of hemifacial spasm in China. Chin Med J (Engl) 2014; 127 (05) 845-849
    PubMedGoogle Scholar
  • 6 Fasano A, Tinazzi M. Functional facial and tongue movement disorders. Handb Clin Neurol 2016; 139: 353-365
    CrossrefPubMedGoogle Scholar
  • 7 Jariyakosol S, Hirunwiwatkul P, Lerdlum S, Phumratprapin C. Prevalence and Associated Factors of Neurovascular Contact in Patients With Hemifacial Spasm. Asia Pac J Ophthalmol (Phila) 2015; 4 (04) 212-215
    CrossrefPubMedGoogle Scholar
  • 8 Abbruzzese G, Berardelli A, Defazio G. Hemifacial spasm. Handb Clin Neurol 2011; 100: 675-680
    CrossrefPubMedGoogle Scholar
  • 9 Defazio G, Livrea P. Epidemiology of primary blepharospasm. Mov Disord 2002; 17 (01) 7-12
    CrossrefPubMedGoogle Scholar
  • 10 Rosenstengel C, Matthes M, Baldauf J, Fleck S, Schroeder H. Hemifacial spasm: conservative and surgical treatment options. Dtsch Arztebl Int 2012; 109 (41) 667-673
    PubMedGoogle Scholar
  • 11 Dou NN, Zhong J, Zhou QM. et al. The mechanism of hemifacial spasm: a new understanding of the offending artery. Neurol Res 2015; 37 (02) 184-188
    CrossrefPubMedGoogle Scholar
  • 12 Nagahiro S. Pathophysiology and surgical treatment of hemifacial spasm. No Shinkei Geka 1998; 26 (02) 101-111
    PubMedGoogle Scholar
  • 13 Sindou MP, Polo G, Fischer C, Vial C. Neurovascular conflict and hemifacial spasm. Suppl Clin Neurophysiol 2006; 58: 274-281
    CrossrefPubMedGoogle Scholar
  • 14 Sindou M, Fischer C, Derraz S, Keravel Y, Palfi S. Microsurgical vascular decompression in the treatment of facial hemispasm. A retrospective study of a series of 65 cases and review of the literature. Neurochirurgie 1996; 42 (01) 17-28
    PubMedGoogle Scholar
  • 15 Mercier P, Bernard F. Surgical anatomy for hemifacial spasm. Neurochirurgie 2018; 64 (02) 124-132
    CrossrefPubMedGoogle Scholar
  • 16 Lefaucheur JP, Ben Daamer N, Sangla S, Le Guerinel C. Diagnosis of primary hemifacial spasm. Neurochirurgie 2018; 64 (02) 82-86
    CrossrefPubMedGoogle Scholar
  • 17 Sekula Jr RF, Bhatia S, Frederickson AM. et al. Utility of intraoperative electromyography in microvascular decompression for hemifacial spasm: a meta-analysis. Neurosurg Focus 2009; 27 (04) E10
    CrossrefPubMedGoogle Scholar
  • 18 Donahue JH, Ornan DA, Mukherjee S. Imaging of Vascular Compression Syndromes. Radiol Clin North Am 2017; 55 (01) 123-138
    CrossrefPubMedGoogle Scholar
  • 19 Ababneh OH, Cetinkaya A, Kulwin DR. Long-term efficacy and safety of botulinum toxin A injections to treat blepharospasm and hemifacial spasm. Clin Exp Ophthalmol 2014; 42 (03) 254-261
    CrossrefPubMedGoogle Scholar
  • 20 Safarpour Y, Jabbari B. Botulinum Toxin Treatment of Movement Disorders. Urr Treat Options Neurol 2018; 20 (02) 4
    CrossrefPubMedGoogle Scholar
  • 21 Karp BI, Alter K. Botulinum Toxin Treatment of Blepharospasm, Orofacial/Oromandibular Dystonia, and Hemifacial Spasm. Semin Neurol 2016; 36 (01) 84-91
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Bhattacharjee S. Treatment of hemifacial spasm: Botulinum toxin versus microvascular decompression. Neurol India 2018; 66 (04) 1043-1044
    CrossrefPubMedGoogle Scholar
  • 23 Yang D, Tao C, Zhou S, Wang Z. The Outcome of Sling Retraction Technique in Microvascular Decompression for Hemifacial Spasm. J Craniofac Surg 2018
    PubMedGoogle Scholar
  • 24 Sindou M, Mercier P. Microvascular decompression for hemifacial spasm: Surgical techniques and intraoperative monitoring. Neurochirurgie 2018; 64 (02) 133-143
    CrossrefPubMedGoogle Scholar
  • 25 Ghali MGZ, Srinivasan VM, Viswanathan A. Microvascular Decompression for Hemifacial Spasm. Int Ophthalmol Clin 2018; 58 (01) 111-121
    CrossrefPubMedGoogle Scholar
  • 26 Mercier P, Sindou M. Introduction to primary hemifacial spasm: A neurosurgical disease. Neurochirurgie 2018; 64 (02) 79-81
    CrossrefPubMedGoogle Scholar
  • 27 Liu LX, Ren YM, Ren PW. et al. Prognosis of Symptoms and Complications After Microvascular Decompression for Hemifacial Spasm: A Single-Center Experience. World Neurosurg 2018 ;•••:S1878–8750(18)31454–2
    PubMedGoogle Scholar
  • 28 Montava M, Rossi V, CurtoFais CL, Mancini J, Lavieille JP. Long-term surgical results in microvascular decompression for hemifacial spasm: efficacy, morbidity and quality of life. Acta Otorhinolaryngol Ital 2016; 36 (03) 220-227
    PubMedGoogle Scholar
  • 29 Liang J, Guo Z, Zhang L, Yu Y. Adolescent-onset idiopathic hemifacial spasm. Neurol India 2014; 62 (02) 175-177
    CrossrefPubMedGoogle Scholar
  • 30 Rudzińska M, Wójcik-Pędziwiatr M, Malec-Litwinowicz M. et al. Is hypertension a risk factor of hemifacial spasm?. Neurol Neurochir Pol 2016; 50 (02) 69-74
    CrossrefPubMedGoogle Scholar
  • 31 Arnone GD, Esfahani DR, Papastefan S. et al. Diabetes and morbid obesity are associated with higher reoperation rates following microvascular decompression surgery: An ACS-NSQIP analysis. Surg Neurol Int 2017; 8: 268
    CrossrefPubMedGoogle Scholar
  • 32 Mercier P, Sindou M. The conflicting vessels in hemifacial spasm: Literature review and anatomical-surgical implications. Neurochirurgie 2018; 64 (02) 94-100
    CrossrefPubMedGoogle Scholar
  • 33 Miller LE, Miller VM. Safety and effectiveness of microvascular decompression for treatment of hemifacial spasm: a systematic review. Br J Neurosurg 2012; 26 (04) 438-444
    CrossrefPubMedGoogle Scholar
  • 34 Sindou M, Keravel Y. Neurosurgical treatment of primary hemifacial spasm with microvascular decompression. Neurochirurgie 2009; 55 (02) 236-247
    PubMedGoogle Scholar
  • 35 Sindou M, Mercier P. Microvascular decompression for hemifacial spasm: Outcome on spasm and complications. A review. Neurochirurgie 2018; 64 (02) 106-116
    CrossrefPubMedGoogle Scholar
  • 36 Cheng J, Lei D, Hui X, Zhang H. Improvement of Quality of Life in Patients with Hemifacial Spasm After Microvascular Decompression: A Prospective Study. World Neurosurg 2017; 107: 549-553
    CrossrefPubMedGoogle Scholar
  • 37 Shibahashi K, Morita A, Kimura T. Surgical results of microvascular decompression procedures and patient's postoperative quality of life: review of 139 cases. Neurol Med Chir (Tokyo) 2013; 53 (06) 360-364
    CrossrefPubMedGoogle Scholar
  • 38 Kim YG, Jung NY, Kim M, Chang WS, Jung HH, Chang JW. Benefits of microvascular decompression on social anxiety disorder and health-related quality of life in patients with hemifacial spasm. Acta Neurochir (Wien) 2016; 158 (07) 1397-1404
    CrossrefPubMedGoogle Scholar